Prone positioning is one of the few proven treatment strategies in severe acute respiratory distress syndrome (ARDS) but little is known about the change in respiratory mechanics around proning. Oesophageal pressures to estimate transpulmonary pressure (PL) can be used to guide lung-protective mechanical ventilation in ARDS. There are two methods to estimate PL, both probably reflecting local PL in different zones of the lung. We present a case where prone positioning resulted in increased oxygenation and improved respiratory mechanics, suggestive of recruited lung volume and more homogeneous distribution of tidal volumes. Further studies are necessary to determine if relative PLin the prone position really reflects the ‘baby lung’.
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